2019 Legislative Report and Scorecard Mental Health Colorado is the state’s leading advocate in promoting mental health, ending stigma, and ensuring equitable access to mental health and substance use services. Mental Health Colorado is a nonprofit, nonpartisan organization and an affiliate of Mental Health America. 2019 Mental Health Colorado Legislative Summary: $20 million increase in spending for mental health and substance use services and supports 41 times Mental Health Colorado staff testified 44 times advocates testified in committee or met with legislators 370 emails sent to legislators advocating for mental health 88 Coloradans advocated for suicide prevention at the Capitol 133 print or broadcast stories regarding our agenda bills We achieved significant policy wins that will: • Increase the availability of mental health services for children and adolescents • Strengthen and enforce laws requiring insurance companies to provide equal coverage for mental and physical care • Ensure people with severe mental illness and substance use disorders receive additional support • Reduce the suicide rate in Colorado • Expand mental health and substance use treatment capacity • Ensure women receive substance use services during and after pregnancy INCREASE THE AVAILABILITY OF MENTAL HEALTH SERVICES FOR CHILDREN AND ADOLESCENTS Mental Health Colorado agenda bill: Senate Bill 19-010 Professional Behavioral Health Services for Schools Sen. Rhonda Fields (D) | Rep. Barbara McLachlan (D) and Rep. Donald Valdez (D) Nearly 70%of Colorado’s 178 school districts are unable to meet national ratio recommendations for mental health or health professionals—resulting in nearly a million underserved students in Colorado. SB19-010 updates and improves the School Health Professionals Grant Program and includes an additional $3 million in time-limited funding to schools to increase the presence of school health professionals to support the behavioral health needs of students. Other legislative accomplishments: • HB19-1017 Kindergarten Through Fifth Grade Social and Emotional Health Act: Creates a pilot program that dedicates a school mental health professional to each grade kindergarten through fifth grade. •SB19-195 Child and Youth Behavioral Health System Enhancements: Requires the state to select a standardized screening and assessment tool to identify child and youth behavioral health needs. The law establishes comprehensive “wraparound” care coordination services and blends funding across agencies to more comprehensively support behavioral health needs. STRENGTHEN AND ENFORCE LAWS REQUIRING INSURANCE COMPANIES TO PROVIDE EQUAL COVERAGE FOR MENTAL AND PHYSICAL CARE Mental Health Colorado agenda bill: House Bill 19-1269 Mental Health Parity Insurance Medicaid Rep. Lisa Cutter (D) and Rep. Tom Sullivan (D) | Sen. Joann Ginal (D) and Sen. Bob Gardner (R) When you’re fighting addiction, depression, or suicidal thoughts, you shouldn’t have to fight for coverage too. Every day, Coloradans are denied coverage for mental health or substance use treatment, put on a waitlist for months without care, or forced to pay thousands of dollars in out-of- pocket costs. We led the fight for the enforcement of mental health parity this legislative session. House Bill 19- 1269 strengthens parity laws, modernizes language, and shifts our system away from expensive, late-stage treatment toward early intervention. It increases consumer protection, holds insurers accountable, and closes loopholes in current law to ensure no more Coloradans fall through the cracks. The law also eliminates prior authorization and harmful step therapy practices for medication-assisted treatment for substance use disorders in private and public insurance. ENSURE PEOPLE WITH SEVERE MENTAL ILLNESS AND SUBSTANCE USE DISORDERS RECEIVE ADDITIONAL SUPPORT Mental Health Colorado agenda bill: Senate Bill 19-222 Individuals At-Risk of Institutionalization Sen. Pete Lee (D) and Sen. Tammy Story (D) | Rep. Daneya Esgar (D) and Rep. Lois Landgraf (R) When we allow our most vulnerable citizens to go to jail because they cannot access treatment, we fail these people, their families, and the taxpayers. Senate Bill 19-222 ensures Colorado will have a behavioral health safety-net system that does not turn people away because they are hard to serve, have a co- occurring condition, or are involved in other systems such as child welfare or the criminal justice system. The legislation increases equity in service access, making civil inpatient beds accessible to residents statewide. It requires the state to implement creative solutions to expand the number of providers who accept Medicaid clients. Mental Health Colorado agenda bill: Senate Bill 19-223 Actions Related to Competency to Proceed Sen. Pete Lee (D) and Sen. Bob Gardner (R) | Rep. Mike Weissman (D) and Rep. Lois Landgraf (R) The legislation overhauls the competency to proceed process in Colorado ensuring that people who are not competent to stand trial due to a mental illness receive treatment sooner. Senate Bill 19-223 is designed to invest the resources needed to prevent people from languishing in jail while waiting for treatment or support for their mental health disorder or intellectual or developmental disability. Mental Health Colorado agenda bill: House Bill 19-1009 Substance Use Disorders Recovery Rep. Chris Kennedy (D) and Rep. Jonathan Singer (D) | Sen. Brittany Pettersen (D) and Sen. Kevin Priola (R) House Bill 19-1009 includes an additional $1 million to expand the availability of housing and support services for individuals who are homeless and have a substance use disorder. It also creates the opioid crisis recovery fund for money the state receives as settlement or damage awards resulting from opioid- related litigation and establishes consumer safeguards related to recovery residences and sober living homes. Mental Health Colorado agenda bill: House Bill 19-1044 Advance Behavioral Health Orders Treatment Rep. Tracy Kraft-Tharp (D) and Rep. Lois Landgraf (R) | Sen. Nancy Todd (D) and Sen. Don Coram (R) House Bill 19-1044 allows Coloradans to create a psychiatric advance directive to specify their preferred methods of treatment in the event of a mental health crisis that prevents them from making decisions for themselves. Other legislative accomplishments: • SB19-008 Substance Use Disorder in the Criminal Justice System: Supports the diversion of Coloradans with substance use disorders who encounter the criminal justice system and reduces barriers to medication-assisted treatment for people involved in the criminal justice system. • HB19-1160 Mental Health Facility Pilot Program: Provides residential care and treatment to people with both a mental health diagnosis and a physical health diagnosis. • SB19-227 Harm Reduction Substance Use Disorders: Expands the availability of opioid overdose reversal medications and other harm reduction measures. REDUCE THE SUICIDE RATE Mental Health Colorado agenda item: Zero Suicide Colorado ranks in the top ten states in suicide, and suicide is now the leading cause of death for Coloradans aged 10 to 24. We secured $100,000 to implement Zero Suicide, an evidence-based approach to reducing deaths by suicide among patients in health care settings. Health care systems that have implemented Zero Suicide have seen reductions in suicide deaths by up to 80% among their patients. Other legislative accomplishments: • HB19-1177 Extreme Risk Protection Orders: Allows a court to issue an extreme risk protection order temporarily removing firearms from a person in crisis who poses a significant risk to self or others. • HB19-1120 Youth Mental Health Education and Suicide Prevention: Allows Coloradans age 12 or older to obtain psychotherapy services without the consent of a parent or guardian. The legislation requires the creation and maintenance of a free mental health education literacy resource bank. It also requires the state board of education to adopt standards related to mental health, including suicide prevention. • HB19-1334 Ban Posting Images of a Suicide: Criminalizes posting or distributing an image of a minor attempting suicide or dying by suicide with the intent to harass, intimidate, or coerce any person and the posting or distribution results in serious emotional distress to any person. EXPAND MENTAL HEALTH AND SUBSTANCE USE TREATMENT CAPACITY Mental Health Colorado agenda bill: House Bill 19-1287 Treatment for Opioids and Substance Use Disorders Rep. Daneya Esgar (D) and Rep. Jim Wilson (R) | Sen. Brittany Pettersen (D) and Sen. Kevin Priola (R) House Bill 19-1287 funds the expansion of substance use treatment capacity in rural and underserved areas of the state, tracks availability of mental health and substance use services for Coloradans in crisis, and funds care navigators to help people access substance use treatment. Other legislative accomplishments: • SB19-001 Expand Medication-Assisted Treatment Pilot Program: Expands the medication-assisted treatment pilot program to additional counties. • HB19-1237 Licensing Behavioral Health Entities: Reforms the regulatory structure for mental health and substance use facility licensing in the state. It establishes a Behavioral Health Entity license within the Colorado Department of Public Health and Environment that will streamline licensing for facilities providing different types of services. ENSURE WOMEN RECEIVE SUBSTANCE USE SERVICES DURING AND AFTER PREGNANCY Mental Health Colorado agenda bill: House Bill 19-1193 Behavioral Health Supports